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The mortality associated with acute subdural hematoma has been reported to range from 36-79%.

Many survivors do not regain previous levels of functioning, especially after an acute subdural hematoma severe enough to require surgical drainage. Favorable outcome rates after acute subdural hematoma range from 14-40%. Several series have shown an increase in favorable outcome in younger patients.[14] Age younger than 40 years was associated with a mortality rate of 20%, whereas age 40-80 years was associated with a mortality rate of 65%. Age older than 80 years carried a mortality rate of 88%. Ultimate prognosis is related to the amount of associated direct brain damage and the damage resulting from the mass effect of the hematoma. Simple acute subdural hematoma (ie, without parenchymal injury) accounts for about half of all cases and is associated with a mortality rate of about 20%. Complicated subdural hematoma (eg, with accompanying contusion or laceration of a cerebral hemisphere) is associated with a mortality rate of about 60%. Findings on CT scan or MRI may help indicate prognosis. Such findings may include the following[15] :

Thickness or volume of the hematoma Degree of midline shift Presence of associated traumatic intraparenchymal lesions Compression of the brainstem or basal cisterns The first CT scan may underestimate the size of parenchymal contusions. In general, a poor preoperative neurologic status may be a harbinger of a poor outcome. In addition to factors discussed above, poor prognostic indicators for acute subdural hematoma have been reported to include the following[16, 17, 15] :

Low initial (< 8) and postresuscitation (< 8) Glasgow coma scale Low Glasgow coma scale motor score on admission (< 5) Pupillary abnormalities Alcohol use Injury by motorcycle accident [18] Ischemic damage Hypoxia or hypotension Difficulty in controlling ICP Elevated ICP postoperatively indicates a poor prognosis and may indicate the severity of the underlying brain injury (eg, trauma, secondary infarction). In a retrospective review of 109 consecutive patients with head injury with a CT scan diagnosis of acute traumatic subdural hematoma, Phuenpathom et al found that poor outcome was strongly correlated with the best sum GCS score within the first 24 hours of head injury and pupillary inequality. Age and pupillary reaction to light also correlated well with the outcome.

The mortality in the whole series was 50%, and mortality for all 37 patients with a GCS score of 3 was 100% (this rate decreased as the GCS increased). The mortality for those with unequal pupils was 64%, versus 40% for those with equal pupils. The mortality associated with one nonreactive pupil was 48%, versus 88% with bilateral nonreactive pupils. The outcome status of the patients with bilateral nonreactive pupils who survived was not noted.[19] Wilberger et al also found an 88% mortality associated with fixed, dilated pupils and noted a 7% functional recovery in survivors with this finding. This study found that neurologic presentation and postoperative ICP (which was not evaluated by Phenpatham et al) were strong predictors of outcome. Wilberger et al also found a trend of increasing mortality rate with age, although it was not statistically significant.[16] A review by Sakas et al of 1-year outcomes following craniotomy for traumatic hematomas in patients with fixed, dilated pupils suggested that the presence of an acute subdural hematoma was the single most important predictor of a negative outcome. Patients with subdural hematomas had a mortality of 64%, compared with a mortality of 18% in patients with extradural hematomas.[20] Seelig et al also showed that neurologic examination findings and postoperative ICP were important prognostic factors. The peak ICP was less than 20 mm Hg in 53% of patients with acute traumatic subdural hematoma (similar to 59% of patients with other types of head injuries), but this group accounted for 79% of the patients with functional recoveries. All patients with uncontrollably elevated ICP (>60 mm Hg) died. These authors claimed a 25% functional recovery rate (defined by the Glasgow Outcome Scale) in patients presenting with fixed, dilated pupils.[21] Acute subdural hematomas that would otherwise be considered operative by imaging criteria may resolve on their own, although this is rare. A series of 4 such patients was reported by Kapsalaki et al.[22] No clear prognostic factors are associated with chronic subdural hematoma. While some authors have found an association with preoperative level of neurological function and outcome, others have not. Early diagnosis before significant neurologic deterioration may correlate with a more favorable prognosis. No correlation has been found between preoperative CT scan findings and postoperative outcome. The mortality within 30 days of surgery is 3.2-6.5%. Eighty percent of patients resume their prehematoma level of function. Sixty-one percent of patients aged 60 years or younger and in 76% of patients older than 60 years have favorable outcomes. In a relatively recent series, 89.4% of patients with chronic SDH who were treated with a closed drainage system had a good recovery and 2.2% worsened.[23]

Mori et al found that old age, pre-existing cerebral infarction, and subdural air after surgery correlated with poor brain expansion.[24] Stanisic et al reported a 14.9% postoperative recurrence rate; various factors were associated with this.[24] The morbidity and mortality rates associated with surgical treatment of chronic subdural hematoma have been estimated at 11% and 5%, respectively. Between 86% and 90% of patients with chronic subdural hematoma are adequately treated after one surgical procedure.